الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Perioperative respiratory adverse events (PRAEs) are a major contributor to anesthesia-related morbidity and mortality in paediatric patients. The presence of PRAE can prolong hospital stays, raise hospital costs by up to 30%, and raise outpatient facility costs. Anesthetic techniques must be used by anesthesiologists in order to decrease the incidence of PRAE and improve the safety of these hospitalized children. PRAEs can occur in up to 50% of children who have tonsillectomies, which is a significant percentage. Age 6 years and younger, upper respiratory tract infection (URTI), lung illness, obesity, obstructive sleep apnea (OSA), and passive smoking are independent risk factors. When children undergo tonsillectomy and adenoidectomy, these factors are very common. Preoperative anxiety and parental deprivation are traumatic for young children and may result in postoperative maladaptive behaviours, such as new onset enuresis, feeding difficulties, apathy, withdrawal, and sleep disturbances. Anxiolysis and smooth parental separation are crucial elements of paediatric preoperative preparation. The perfect premedication should have few side effects, a quick onset, short duration of action, ease of administration, and patient acceptance. Compared to orally delivered medications, the nasal route of drug administration skips the enterohepatic circulation, which improves bioavailability and reduces the bitter taste of the drug. Dexmedetomidine (DEX) affects the locus coeruleus’ α2 adrenergic receptors, hastening the onset of drowsiness and simulating natural sleep with less respiratory depression. Easy arousability without impairing the patient’s orientation or cooperation is a hallmark of dexmedetomidine sedation. DEX reduces coughing and has been demonstrated in studies to directly affect the smooth muscles of the airway. Children with significant respiratory morbidities who were at increased risk for PRAE also revealed this beneficial profile in attenuating airway reflexes. The aim of this study was to detect the efficacy of intranasal dexmedetomidine as a premedication to general anesthesia in pediatric patients with respiratory comorbidities undergoing adenotonsillectomy. This prospective double-blind randomized controlled study was carried out in Tanta University Hospitals in the Department of Anasethiology for 6 months from November 2022 to April 2023 on seventy pediatric patients between 3 -10 years undergoing adenotonsillectomy with recent mild upper respiratory tract infection. The patients were randomly classified into two groups; 35 patients in each group.